Fetal Pulmonary Artery Diameters Research Articles

Increase in fetal pulmonary artery diameters during late gestation is a predictor of outcome in congenital diaphragmatic hernia with liver herniation

Aim Liver herniation (LH) in congenital diaphragmatic hernia (CDH) may not be a reliable prognostic indicator. We measured pulmonary artery (PA) diameters in CDH + LH as an alternative. Methods Of 41 consecutive cases of prenatally diagnosed left-sided CDH treated from 2002 to 2010, 19 had CDH + LH and 22 had CDH − LH. Ultrasonography and magnetic resonance imaging were used to assess LH and echocardiography to measure PA diameters during the third trimester (fetal; 32-34 weeks), at birth, and on day 2 of life. Results In CDH + LH survivors (9/19; 47%), fetal right PA (RPA) diameters were significantly larger than in nonsurvivors (2.58 ± 0.56 vs 1.82 ± 0.35 mm; P < .01), but left PA (LPA) diameters were not (1.73 ± 0.38 vs 1.59 ± 0.22). In survivors, fetal RPA was greater than 2 mm in all but one case, and both PA diameters increased significantly by birth (RPA, 2.58 ± 0.56 vs 3.52 ± 0.54; LPA, 1.73 ± 0.38 vs 2.60 ± 0.40; both P < .01). Final diameters at birth in survivors were at least 2.5 and 2.0 mm, respectively. In nonsurvivors, both PAs were significantly smaller (RPA, 3.52 ± 0.54 vs 2.04 ± 0.31; LPA, 2.60 ± 0.40 vs 1.68 ± 0.18; P < .01), with no observed increase by birth. Survival in CDH − LH was 82% (18/22). Conclusion PA diameter appears to be correlated with prognosis in infants with CDH + LH.

Fetal pulmonary artery diameter measurements as a predictor of morbidity in antenatally diagnosed congenital diaphragmatic hernia: A prospective study

The objective of the study was to examine the size and growth of fetal pulmonary artery diameters in congenital diaphragmatic hernia and assess their correlation with postnatal survival and morbidity outcomes. Prospective antenatal echocardiographic examination of fetal branch pulmonary arteries were correlated with postnatal survival and respiratory morbidity in cases of congenital diaphragmatic hernia. Receiver operator curves were developed to assess their utilization as predictors of respiratory morbidity and survival. Twenty-one cases were diagnosed antenatally over 3 years. Fifteen subjects survived postnatally. The ipsilateral fetal branch pulmonary artery diameter was smaller throughout gestation in left-sided congenital diaphragmatic hernia (P = .008). The small left pulmonary diameter did not correlate with survival but correlated strongly with morbidity outcomes. Progressive ipsilateral fetal pulmonary artery hypoplasia was demonstrated throughout gestation in subjects who died or had severe morbidity. Fetal pulmonary artery diameter measurements correlate with respiratory morbidity in postnatal congenital diaphragmatic hernia and may assist with prediction of outcome. Survival has improved, possibly because of improved postnatal management of congenital diaphragmatic hernia, limiting this measurement in assessing survival.

P05.19: Constriction and complete occlusion of the ductus arteriosus associated with maternal use of acetaminophen

Objectives: 1) To establish normograms (using predicted interval formulas) of fetal pulmonary artery diameters and ratios as a function of fetal biometric parameters (FBP). Study design: Cross sectional study: Fetuses with the following criteria following fetal echocardiography were recruited for this study: 1) known gestational age based on LMP or early ultrasound, 2) unremarkable fetal echocardiogram study, 3) full fetal biometry, 4) singleton gestation, and 5) no major anomalies. Data of the following pulmonary artery (PA) parameters were taken if measured in each fetus at least three times: 1) Main PA (MPA) diameter, 2) Right branch PA diameter, 3) Left branch PA diameter and 4) Ascending Aorta. The following ratios were calculated: MPA/RPA, RPA/LPA, MPA/LPA and MPA/AO. Pearson coefficients (P) were calculated for each parameter versus the following FBP: 1) Biparietal diameter, 2) Head circumference, 3) Abdominal circumference (AC), 4) Femur length (FL), 5) Estimated fetal weight and 6) Calculated fetal gestational age (CFGA) based on biparietal diameter and femur length. Predicted interval normograms (95%tile confidence intervals) were developed using SPSS for fetal pulmonary artery diameters and ratios. Results: One hundred and fifty-five fetuses have been enrolled in this study. Gestational age range was 124–272 days. PA diameters were well correlated to all the FPB (all P > 0.85), suggesting a stable linear relationship. Arterial diameter ratios were stable across the gestational age range studied and appeared independent of FPB. Conclusions: Normograms (based on Predicted Intervals, 95% CI) for fetal PA diameters and ratios are established for a variety of FBP. In the absence of known gestational age, these normograms of fetal pulmonary artery diameters can be used reliably as a basis of comparison.

P05.18: Left ventricular aneurysm in a fetus complicated by arrhythmias

Objectives: 1) To establish normograms (using predicted interval formulas) of fetal pulmonary artery diameters and ratios as a function of fetal biometric parameters (FBP). Study design: Cross sectional study: Fetuses with the following criteria following fetal echocardiography were recruited for this study: 1) known gestational age based on LMP or early ultrasound, 2) unremarkable fetal echocardiogram study, 3) full fetal biometry, 4) singleton gestation, and 5) no major anomalies. Data of the following pulmonary artery (PA) parameters were taken if measured in each fetus at least three times: 1) Main PA (MPA) diameter, 2) Right branch PA diameter, 3) Left branch PA diameter and 4) Ascending Aorta. The following ratios were calculated: MPA/RPA, RPA/LPA, MPA/LPA and MPA/AO. Pearson coefficients (P) were calculated for each parameter versus the following FBP: 1) Biparietal diameter, 2) Head circumference, 3) Abdominal circumference (AC), 4) Femur length (FL), 5) Estimated fetal weight and 6) Calculated fetal gestational age (CFGA) based on biparietal diameter and femur length. Predicted interval normograms (95%tile confidence intervals) were developed using SPSS for fetal pulmonary artery diameters and ratios. Results: One hundred and fifty-five fetuses have been enrolled in this study. Gestational age range was 124–272 days. PA diameters were well correlated to all the FPB (all P > 0.85), suggesting a stable linear relationship. Arterial diameter ratios were stable across the gestational age range studied and appeared independent of FPB. Conclusions: Normograms (based on Predicted Intervals, 95% CI) for fetal PA diameters and ratios are established for a variety of FBP. In the absence of known gestational age, these normograms of fetal pulmonary artery diameters can be used reliably as a basis of comparison.

Fetal pulmonary artery diameters and their association with lung hypoplasia and postnatal outcome in congenital diaphragmatic hernia

Objective: We hypothesized that fetal branch pulmonary artery (PA) diameters indirectly reflect lung mass and are associated with postnatal outcome in cases of isolated congenital diaphragmatic hernia (CDH). Study Design: We retrospectively reviewed echocardiograms of fetuses with CDH, measuring branch PA diameters and other echocardiographic parameters. Antenatal parameters were correlated with postmortem lung weights in 5 fetuses after pregnancy termination. Fetal echocardiographic measures were correlated with outcome variables in 29 live-born infants with CDH to identify antenatal indices associated with postnatal death and respiratory morbidity. Results: Antenatal branch PA size correlated with postmortem lung weights from 5 terminated fetuses (r = 0.87). In 26 cases of left CDH in which the fetus continued to term, the ipsilateral branch PA diameter was significantly smaller than the contralateral branch PA diameter at presentation (P <.001). In these fetuses, a larger contralateral PA diameter was associated with worse postnatal survival (P =.049). Among survivors with left CDH, the main PA z score and the discrepancy between right and left PA diameters correlated positively with duration of supplemental oxygen requirement (P =.019 and P =.022, respectively) and ventilation (P =.036 and P =.012, respectively). Serial antenatal studies in 8 of 10 cases revealed progressive ipsilateral PA hypoplasia. Conclusion: Antenatal branch PA size correlates with postmortem lung weight. A larger contralateral PA, and significant branch PA discrepancy and larger main PA diameter, best correlate with postnatal death and respiratory morbidity, respectively. Progressive ipsilateral PA hypoplasia suggests progressive in utero lung hypoplasia in cases of CDH. (Am J Obstet Gynecol 2002;186:1085-90.)